Efficacy of a reduced-drug burden quadruple therapy with vonoprazan, cefuroxime, minocycline, and bismuth for Helicobacter pylori eradication: a retrospective study.

BACKGROUND AND AIMS: Few studies have evaluated the efficacy and safety of vonoprazan, cefuroxime, minocycline, and bismuth (VCMB) quadruple therapy (with vonoprazan 20 mg once daily and cefuroxime 250 mg twice daily) for Helicobacter pylori (H. pylori) eradication. This retrospective pilot study aimed to assess the efficacy and safety of a 14-day VCMB regimen for H. pylori infection. METHODS: This retrospective analysis enrolled patients treated with a 14-day VCMB quadruple therapy. The included patients were 18-80 years old and positive for 1 3C urea breath test (1 3C-UBT). VCMB quadruple therapy consists of vonoprazan 20 mg once daily, cefuroxime 250 mg twice daily, minocycline 100 mg twice daily and bismuth potassium citrate 220 mg twice daily. 1 3C-UBT was repeated 4-6 weeks after treatment to evaluate the H. pylori eradication efficacy. RESULTS: A total of 106 patients were enrolled. The intention to treat (ITT) and per-protocol (PP) eradication rates were 90.6% (95% CI: 82.9-95.1) and 96.0% (95% CI: 89.5-98.7). The overall incidence of adverse events was 21.9%. Mild dizziness and nausea were the most common adverse events, and these symptoms resolved spontaneously without additional treatment. CONCLUSIONS: The 14-day VCMB quadruple therapy, in which both vonoprazan and cefuroxime were administered at half their usual total daily doses, achieved a favorable H. pylori eradication rate, a low incidence of adverse events and good patient adherence. It is a potential new regimen for H. pylori eradication, further prospective multicenter studies are warranted to validate its efficacy and safety.